[Vaccine co-administration in clinical practice]. / Somministrazione contemporanea dei vaccini nella pratica clinica.

Vaccines are biological products designed to induce a protective immune response, mimicking natural infection without the development of disease and / or complications. Combined vaccine administration and vaccines co-administration is a safe and effective practice, the benefits of which outweigh the disadvantages. The operators should assess individual variations for the completion of the vaccination schedule, which may be necessary in clinical practice, case by case. Often there are myths to dispel, such as fears about the overload of the immune system, the remora to do more injections in the same session, excessive reactogenicity and some false contraindications. The operators, in order to resolve their doubt in performing non-routine co-administrations, can rely on the Summary of Product Characteristics (SPC) of the individual vaccines and on the new available evidence.

[Incidence of biological accidents at work and immune status for vaccine-preventable diseases among resident physicians in specialist training at Ferrara University Hospital]. / Studio di incidenza sugli infortuni biologici nei medici in formazione specialistica dell'Azienda Ospedaliero - Universitaria di Ferrara e stato immunitario nei confronti delle principali infezioni prevenibili.

The hospital as a work environment is particularly characterized by various risks for healthcare workers (HCWs). The main risk is represented by biological accidents, associated with the parenteral transmission of pathogens. Biological injuries can occur during the care service and the manipulation of biological fluids. Hepatitis B (and hepatitis D), hepatitis C and HIV are the most common infections transmitted by biological injuries. Physicians should acquire awareness of the risks associated with their professional activity during their training as medical residents (MRs). Some infectious diseases are preventable by vaccination and the "National Immunization Plan 2017-2019" (PNPV) recommends HCWs vaccination against hepatitis B, influenza, measles -mumps -rubella, chicken pox, and pertussis. Besides, not only HCWs' vaccination can prevent the disease in healthcare professionals, but it also may reduce the transmission to patients. Therefore, active immunization of HCWs by recommended vaccinations plays an important role to prevent disease cases, complications and death in patients. An increased awareness of risk behaviors is the first important point to address in order to reduce biological accidents and infectious diseases transmission, so as to reduce their frequency. Besides, HCWs' vaccination is useful to reinforce protection and to prevent the transmission of some infectious diseases in case of exposure. The aim of this five-year incidence study is to investigate the MRs' biological accidents characteristics and to analyze the MRs' immune status at the University of Ferrara in the period 2011-2015. Data on MRs' biological accidents and immune status at Azienda Ospedaliero-Universitaria of Ferrara in 2011-2015 were analyzed by Microsoft Excel 2007 Software. In this study, the percentage of MRs' biological injuries compared to the total number of MRs showed an annual variability, with a peak in 2011 (11.9%). During the analyzed period, there were 190 biological injuries among the MRs: 81% were percutaneous injuries and blood was the biological fluid involved in 86.3% of cases. The most frequent lesion was puncture (62.6%), occurred in 41.1% of cases by suture needles; 46.3% of accidents occurred in the operating block. These data can be explained by the more invasive and at risk activities carried out in these Operative Units. The high injuries percentage in MRs may be related to less work experience and inadequate training or informations about personal protective equipment use. Among MRs, 93.7%, 93.3% and 96.6% were immune to measles, chicken pox and hepatitis B, respectively; only in the case of rubella, 11.9% of MRs was not immune. This research showed, accordingly to published data, high adhesion to hepatitis B vaccination. However, the healthcare workers' vaccine coverage is still sub-optimal; active immunization by recommended vaccines should be implemented for both parenteral and airborne diseases. As a matter of fact, the recent measles outbreak has involved healthcare workers (4689 cases of measles, 305 in HCWs). Finally, the General Directorates of Health-care settings should improve healthcare personnel adhesion to vaccinations, such as influenza, by promotion activities in the workplace. A proposal in order to achieve coverage objectives could be making vaccinations mandatory, as well as already implemented in other countries.

[The public health importance of vaccinations in the elderly: an evidence-based guide]. / L'importanza delle vaccinazioni nell'anziano nell'ambito della Sanità Pubblica: una guida basata sulle prove scientifiche.

Ageing represents an extremely current issue globally, and involves especially European populations. It is estimated that in Europe by the year 2025, about a third of the population will be over 60 years of age, hence the imperative for "healthy ageing". Vaccinations in seniors, in contrast with paediatric vaccinations, are very often neglected even by health care workers. This article aims to provide an evidence-based guide to establish vaccinations in seniors as one of the pillars of Public Health in the future.

Impact of Pertussis on the Italian population: Analysis of hospital discharge records in the period 2001-2014.

OBJECTIVES: The study aimed to analyze and update the impact of pertussis on the Italian population by evaluating pertussis-related hospital admissions in the period 2001-2014. DESIGN OR METHODS: Hospital Discharge Records (HDR) were provided by the National Archive of HDR data of the Ministry of Health. Only hospitalizations included in the primary diagnosis were evaluated. Significant trends over the considered years were assessed as average annual percent changes (AAPC) applying the Joinpoint model. RESULTS: A total of 7,102 hospital admissions for pertussis (main diagnosis) were registered; the trend of hospitalizations progressively decreased from >1/100,000 inhabitants in the years 2001-2004 to 0.64/100,000 inhabitants in 2014. A great part of hospitalizations (63.6%) involved subjects <1 year of life; almost 20% of cases were registered in the age class 5-14 years. The Joinpoint analysis showed a statistically significant variation in some age classes. CONCLUSIONS: Even if this study shows a decreasing trend in the number of pertussis-related hospitalizations, the impact of the disease in Italy in terms of hospital admissions continues to be relevant, especially in the <1 year age class. Pertussis therefore continues to be, in Italy as well as in other European countries, an important public health issue.

A novel nonlive, adjuvanted herpes zoster subunit vaccine: a report on the emerging clinical data and safety profile.

Herpes zoster (HZ) is an acute vesicular dermatitis with a typical dermatomal distribution, caused by the varicella zoster virus (VZV), often preceded and accompanied by prodromal pain or pruritus. HZ may be related to several complications such as postherpetic neuralgia (PHN). The incidence and severity of the disease increase with aging, due to immunosenescence and in particular to the decline of the specific cell-mediated immunity (CMI). The impact of HZ in terms of morbidity and short- and long-term complications, the availability of suboptimal treatment options to date, and the high costs for the diagnostic and clinical-therapeutic management of patients have motivated the search for a new preventive approach through the development of a vaccine. The vaccine currently in use with live-attenuated virus (ZVL) has been shown to be effective in reducing the incidence of HZ, its impact, and the onset of PHN, although the efficacy is lower in older subjects and tends to decrease some years after immunization. A new adjuvanted recombinant subunit vaccine (HZ/su), containing the VZV glycoprotein E (gE) and the AS01B adjuvant system, is now a very promising alternative to ZVL; in several clinical studies, it showed a good safety profile and was able to elicit high immune humoral and cell-mediated responses, both maintained up to 9 years. Furthermore, HZ/su vaccine was effective both in preventing HZ and in reducing the onset of PHN and other complications. HZ/su has been recommended and preferred over ZVL by the Advisory Committee on Immunization Practices (ACIP) for the prevention of HZ and its complications in immunocompetent adults aged ≥50 years, even if already vaccinated with ZVL, through a two-dose schedule. HZ/su has been approved in Canada, USA, Europe, and Japan and is currently being approved in Australia. The aim of this review was to describe the epidemiological data, HZ and PHN risks and their impact on the social life and common life of infected people, and ZVL and HZ/su vaccine development including various clinical trials and efficacy, safety, and tolerability profiles.

Human respiratory syncytial virus and hospitalization in young children in Italy.

BACKGROUND: Human respiratory syncytial virus (hRSV) is ubiquitous and causes respiratory diseases in both children and adults. Worldwide, hRSV pneumonia is the second cause of postnatal infant death after malaria. Given the high impact in terms of morbidity, mortality and costs, especially in the pediatric population, hRSV is recognized as a global health problem and the WHO, in view of the availability of new vaccines, has urged an active surveillance program of virus-related infections. The aim of this study has been to evaluate the impact of hRSV infections in the Italian population, particularly the pediatric one, in terms of hospitalizations. METHODS: In the period 2001-2014, Hospital Discharge Records (HDRs) with the following diagnosis codes included in the primary diagnosis were evaluated: 466.11 (hRSV bronchiolitis), 480.1 (hRSV pneumonia) and 796 (hRSV). HDRs were supplied by the National Archive of HDRs data, Ministry of Health. RESULTS: During the period 2001-2014, 57,656 hospital admissions due to hRSV pathologies were performed. Most hospitalizations (88.8%) involved patients with less than 1 year of age. Considering only primary diagnosis, 93% of the admissions were due to bronchiolitis, 5% to pneumonia and 2% to not otherwise specified hRSV infections. In the period 2001-2014, the hospitalization rate in 0-2 years old children, was equal to 224.8, 9.6 and 4.6/100,000 for hRSV bronchiolitis, hRSV pneumonia and not otherwise specified hRSV infection, respectively. CONCLUSIONS: This study confirms the high impact of hRSV on the pediatric population in the age class 0-4 years, with a peak in the first 12 months of life. Most hospitalizations were urgent, although the duration of the hospital stay was for the most part less than a week, with ordinary discharge at home. Pending the conclusion of ongoing clinical trials on different hRSV vaccine types, it is extremely important to have updated data on the impact of hRSV-related pathologies in the various age groups.

Single inherited thrombophilias and adverse pregnancy outcomes.

INTRODUCTION: Inherited thrombophilia is believed to be a multiple gene disease with more than one defect. We aimed to determine the association between single thrombophilic patterns and a variety of pregnancy diseases. METHODS: 284 pregnant women were recruited for the present study and were divided in two groups: A group (176 controls) and B group (108 cases). Patients belonging to the B group had one of the following: severe pre-eclampsia, hemolysis, hepatic enzymes increase, hypertension and low platelet count (HELLP) syndrome, gestational hypertension, fetal growth restriction, intrauterine death, abruptio placentae and disseminated intravascular coagulopathy. To detect methylenetetrahydrofolate reductase (MTHFR) A1298C, MTHFR C677T, factor V Leiden, PAI-1, mutant prothrombin G20210A, an inverse hybridization technology was used. Plasma homocysteine, antithrombin (AT) III and protein S were determined. A modified functional activated protein C resistance was detected. RESULTS: MTHFR C677T and hyperhomocysteinemia were more prevalent than other thrombophilias. Deficiency in AT III was significantly linked with pre-eclampsia (relative risk 0.88; 95% CI 0.83-0.94). Activated protein C resistance (APCR) was significantly related to the abruptio placentae (relative risk 0.71; 95% CI 0.61-0.82). COMMENTS: Apart from the linkage between AT III deficiency and the occurrence of pre-eclampsia, and apart from the increased risk of abruptio placentae in pregnant women with altered APCR, we obtained findings in contrast with some of the published literature. In our case series, no association of pre-eclampsia with factor V Leiden or with prothrombin gene mutation was found.